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September 28, 2006

Hyperglycemia and DKA, Other Illnesses

Question from Pakistan:

My six year old daughter was diagnosed with type 1 diabetes in March 2006. She was admitted to the hospital and discharged on insulin injections twice a day, six units in the morning and four units in the evening. Her A1c was 8.4 after three months. She had a viral flu and her fever went to 104 degrees. She was hospitalized for two days where she was treated by injectable antibiotics and Calpol 6. She had some laboratory tests done and all results were fine; even her malaria test was negative. While she was in hospital, her sugar level was fluctuating from 57 mg/dl [3.2 mmol/L to over 350 mg/dl [19.4 mmol/L]. She was discharged after two days. Now, she is has a sore throat and has had a fever for 12 hours. Her blood sugar remains 250 to over 390 mg/dl [13.9 to 21.7 mmol/L]. I need to ask if the high sugars are causing the virus or are caused by the viral flu and sore throat.

Answer:

As I understand your question, your child was diagnosed with type 1 diabetes in March 2006. Recently, she had a febrile illness with a temperature of 104 degrees and her glucose levels fluctuated. Now, she has another febrile illness with sore throat and her glucose levels are maintaining high. And your question is: Is this illness leading to the high glucose levels OR are the high glucose levels leading to the illness?

The most likely explanation is that this new illness with fever is leading to the higher glucose readings. Illness, especially those with fever, lead to the release of stress hormones, such as cortisol and epinephrine, and these can lead to higher glucose. You should be checking glucose levels often and watching for ketones.

VERY poorly controlled diabetes may predispose to easy susceptibility to some infections (such as fungal infections), but in a six year old girl with an A1c of 8.4, I think that would be less likely.

If we have misinterpreted your question, please clarify.

DS